Transurethral Microwave Thermotherapy
(Reprinted with permission from M.D. News, Phoenix Edition, April 2005)
As men age, the prostate may enlarge. This is a condition known as Benign Prostatic Hyperplasia (BPH). While not a disease, BPH often accompanies the aging process, and is brought about by an increase in the amount of dihydrotestosterone within the prostate. The result is a boost in the number of prostate cells (hyperplasia) and thus, an enlargement. As the prostate grows, it may squeeze the urethra, restricting urinary flow, and incite urinary tract infections, bleeding, the formation of stones, or in the worst case kidney failure. According to the American Urology Association (AUA), abnormal growth of the prostate begins after the age of 40, and is found in 60 percent of men over 60, and for men over 80, as many as 80 percent will develop BPH to some degree. Symptoms of BPH can include a sensation of a frequent need to urinate, a feeling of not being able to fully empty the bladder, needing to urinate frequently during the night, or a weak urine stream. BPH is diagnosed by a doctor through a physical examination. Urinalysis is done for signs of blood, glucose or infection. Traditionally, treatment for BPH has been to decrease the volume of the prostate via surgery or soften the tissue or to get the tissue of the prostate to relax using medications. These drugs are called alpha Mockers and inhibitors of 5 alpha reductase. While either group of these drugs or a combination therapy will block future growth of the prostate, the disadvantage to drug therapy is that the symptoms of BPH may not be relieved for three to six months. As well, possible side effects include a reduction in semen, decreased sexual desire and inability to achieve an erection. Because these drugs can change the cancer screening prostate specific antigen (PSA) test by as much as 50 percent, patients undergoing drug therapy require more frequent testing. For many men, the ongoing costs of the drug therapy can be an issue. A surgical procedure called transurethral resection of the prostate (TURP) may be elected, and is frequently chosen if BPH has brought about other serious problems. In this procedure, the inner section of the prostate is surgically removed. Performed under anesthesia, TURP may rapidly relieve the patient's symptoms. According to the AUA, TURP may result in complications as serious as difficulty in achieving an erection, incontinence and scarring of the urethra. Urgency and frequency of urination may also be experienced for some time after the surgery. With TURP, there is also the potential for retrograde ejaculation, a side effect wherein semen is pumped back into the bladder. Lastly, another downside to TURP is that 10 percent of patients may need to have the procedure performed again within five years after the initial surgery. Technology now offers patients with BPH an alternative to drugs or surgery through a minimally invasive treatment called transurethral microwave thermotherapy (TUMT). TUMT was pioneered by then privately owned TherMatrx™ in 1997 as an in office treatment for BPH and received FDA approval in June of 2001. In July of 2004, TherMatrx™ was acquired by American Medical Systems, Inc., a Minnetonka, MN based world leader in medical devices for the treatment of urinary obstructions, erectile dysfunction and incontinence. As the name of the procedure implies, TherMatrx™ relies on microwaves for the patented Dose Optimized Thermotherapy™ (DOT) to provide an effective single visit, non-surgical treatment performed at a urologist's office. Microwaves are very high frequency radio waves that twist back and forth at a frequency of about two billion cycles per second. Like a microwave oven, the phenomenon of dielectric, polarization occurs when microwaves cause a material's molecules to gyrate into thermal energy, heating that material. The TUMT procedure essentially cooks the prostate tissue, causing cell death, and the result is a shrinkage of the prostate. Dr. Charles Tomaszewski, M.D., has been treating patients with the TherMatrx™ system in his Phoenix, AZ, office for four years and has performed more than 300 treatments. Dr. Tomaszewski says, "This technology is sort of in the middle between surgery and medication. It replaces what the surgery does without the potential complications of surgery. It works better than the medications, which have side effects such as sexual dysfunction and interactions with some high blood pressure medications." Treatment requires just one, 60-minute office visit. When he opened his Phoenix based solo practice in 1993, Dr. Tomaszewski worked mainly with impotence, erectile dysfunction and female incontinence, as well as general urology. Having seen a great deal of patients with prostate enlargement and prostate diseases, he eventually became a specialist in dealing with the prostate and the technology used for its treatment. TUMT is a relatively simple procedure. Patients are evaluated prior to the procedure by undergoing cystoscopy (looking into the bladder) and a prostate ultrasound. Cystoscopy allows the doctor to look for stones in the bladder and determine the exact configuration of the prostate. Ultrasound is used to measure the varying lengths of prostates so that the correct size treatment catheter can be selected for the procedure. According to Dr. Tomaszewski, patients for whom during the evaluation are discovered to have a median lobe—a "knuckle of tissue" that intrudes into the bladder—are not eligible to be treated by the TherMatrx procedure.
Patients eligible for the TUMT procedure will begin by taking a prescribed tranquilizer, antibiotic and anti inflammatory prior to arrival at the urologist's office. Upon treatment, the patient first receives an injection of pain medication; the area is then anesthetized as the treatment catheter is placed in the urethral passage and into the bladder. Ultrasound is used to check for proper location of a balloon affixed to the end of the treatment catheter to ensure proper placement of the treatment coil in the region of the prostate. Sensors are then placed into the catheter which detect the temperature within the prostate, ensuring the highest efficiency. An additional sensor is placed through a probe into the rectum so it is not damaged by the heat. The machine is then turned on, and the temperature in the prostate is brought to 50 degrees C. This stage takes about 20 minutes. The second stage takes place as the temperature is held for 40 minutes. It is the 50 degrees C temperature that causes the damage to the prostate tissue. Dr. Tomaszewski says, "Most patients fall asleep during the procedure. Some patients feel a sense of warmth in the prostate area, while others may feel a need to urinate, though most everyone finds it tolerable." After the TUMT procedure, the prostate will swell, and the treatment catheter is removed and replaced by a softer catheter, which will continuously drain the urine into a small bag attached to the patient's leg. This catheter will remain in the patient for four days, at the end of which the patient will be instructed on how to remove it himself. Dr. Tomaszewski says, "The patient is always instructed on how to remove the catheter during the morning or day while I'm in the office, so that in case there is any problem, I'm readily available." And that is about all there is to it. Symptoms generally improve in four to six weeks. Patients are usually fully healed in six weeks to three months. "Most patients will have already been on one of the two types of medications, either the alpha blocker or the 5 alpha reductase inhibitor, before coming in for the procedure. I'll keep them on that medication for about a month. If at the point of their follow up, if they are doing well, we stop the medication. I would say about 95 percent of the patients treated do not go back on the medication. For the 5 percent for whom TUMT does not work well, some of them will need to stay on the medication, and some will need to undergo prostate surgery," says Dr. Tomaszewski. TUMT is covered by most insurance plans including AHCSS and Medicaid. In addition to his high-tech treatment for BPH, Dr. Charles Tomaszewski offers treatment for erectile dysfunction through non invasive and non surgical procedures, as well as general urology. Dr. Tomaszewski is also the local expert in removal of the prostate through a procedure called radical perineal prostatectomy. This procedure allows patients quicker recovery, shorter hospital stays and lower incidence of incontinence and erectile dysfunction. For more information, contact Charles S. Tomaszewski, M.D., Diplomate of the American Board of Urology, Fellow of the American College of Surgeons; Web: www.associatedurologists.net. (Address and phone are below.)  Charles Tomaszewski, M.D. Parkway 70 Plaza 1255 Route 70, Suite 33-S Lakewood, NJ 08701 Tel: 732.364.1664 Fax: 732.364.1667 Map |
Comedian Billy Crystal once described the aging process and the enlargement of the prostate as learning to "urinate in Morse Code" (dot dot dash dot, etc.).